Information

  • Com Number

  • Conducted on

  • Prepared by

  • Location
  • Inspection Date

  • Inspection Type

  • Person interviewed

  • Premises Type

  • Owner

  • Email address

GENERAL

  • Type of Circulation System

  • Dosing System

  • Secondary treatment system?

  • Test Kit Method for testing

  • Testing Frequency

  • Records log book maintained?

Pool 1

  • Disinfectant Type

  • Pool size

  • Location

  • Water temperature (°C)

  • Free Chlorine (mg/L)

  • Total Chlorine (mg/L)

  • Combined Chlorine (mg/L)

  • pH range

  • Total alkalinity (mg/L)

  • Cyanuric Acid

  • Comments

Pool 2

  • Disinfectant Type

  • Pool size

  • Location

  • Water temperature (°C)

  • Free Chlorine (mg/L)

  • Total Chlorine (mg/L)

  • Combined Chlorine (mg/L)

  • pH range

  • Total alkalinity (mg/L)

  • Cyanuric Acid

  • Comments

Pool 3

  • Disinfectant Type

  • Pool size

  • Location

  • Water temperature (°C)

  • Free Chlorine (mg/L)

  • Total Chlorine (mg/L)

  • Combined Chlorine (mg/L)

  • pH range

  • Total alkalinity (mg/L)

  • Cyanuric Acid

  • Comments

General

  • Pool Cleanliness

  • Change Room Cleanliness

  • Other Comments

RESULTS

  • Inspection Result

  • Action Required

  • Other comments

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